IVF Program

• Overview
• IVF/Advanced options
• ICSI
• MESA/TESE
• Blastocyst Culture and Transfer
• Hatching
• PGS
• Embryo/ Gamete Cryopreservation
• Donor Egg
• Success Rates

IVF/Advanced Options

* Pre-IVF Testing: Prior to beginning IVF stimulation, we must ensure that you have a normal uterine cavity, enough sperm to allow fertilization to occur, and ovaries capable of producing viable oocytes. In addition, there are specific tests for certain infectious diseases. These tests include such things as Human Immune Deficiency Virus (HIV), Hepatitis B and C, and Syphilis. We also screen women for immunity to Rubella (German measles) and Varicella (chicken pox).

* Trial (or Mock) Transfer: Every patient’s uterus is unique. Some are tilted forward (anteflexed), some are tilted backward (retroflexed), and some are straight. Some are larger, while others are smaller. Some have a cervix that is partially open; some have a cervix which is tightly closed. In order to minimize discomfort at the embryo transfer and maximize the likelihood of success, we will usually perform a trial transfer prior to initiating ovarian stimulation. This quick and painless office procedure involves passing a very thin plastic catheter through the cervical canal into the uterus. At that time, we will assess and/or measure three things: the distance from the cervical opening to the top of the uterine cavity, the degree.of curvature of the canal itself, and the ultimate position of the top of the uterus. For example, if your measurement is “70/30/12”, this means that it is 70 mm from the cervical opening to the top of the cavity, there is a 30 degree curvature in the canal, and the uterus is anteflexed. We will use this measurement to determine where to place the embryos at the time of the actual embryo transfer. Studies have shown that patients who have a trial transfer have higher pregnancy rates and less difficulty at the time of the actual transfer.

* Suppression: Prior to initiating ovarian stimulation for in vitro fertilization, most Reproductive Endocrinologists choose to suppress both your ovaries and your pituitary gland. This is typically accomplished by giving 3-4 weeks of birth control pills, followed by Lupron injections. Studies have shown that at any given time, the ovaries contain oocytes at various stages of development. Suppressing the ovaries with birth control pills in the cycle preceding ovarian stimulation allows more oocytes to respond to stimulation, In addition, Lupron prevents the pituitary from releasing a surge of Luteinizing Hormone (LH), which could trigger spontaneous ovulation and result in cycle cancellation.

* Stimulation: Daily gonadotropin injections (typically 8-12 days) stimulate the egg containing ovarian follicles to grow and develop. Careful monitoring with transvaginal ultrasounds and blood tests will allow your physician to make necessary adjustments to your treatment regimen in order to maximize your response and minimize any complications from the fertility drugs. Once the follicles have reached their ideal size, a subcutaneous injection hGC or Ovidrel (which mimics your body’s own hormonal LH surge), causes final maturation of the eggs prior to retrieval.

* Egg Retrieval: The oocyte retrieval occurs approximately 36 hours after you receive the hCG shot. The oocyte retrieval is performed in a procedure room within our IVF Surgery Center. A board certified anesthesiologist will provide intravenous sedation to prevent any pain or discomfort during the procedure. Under ultrasound guidance, a very thin needle is passed through the upper portion of the vagina directly into the ovarian follicles. The follicular fluid containing the egg is aspirated and transported to our adjoining laboratory where our embryologists identify the egg, remove it from the fluid, and place it into a culture solution.

* Fertilization: Approximately 5-6 hours after retrieval, the sperm preparation obtained from either the male partner, or sperm bank, in cases where donor sperm is used, is placed into a specialized culture solution with the egg. Prior to this time, the specimen is washed and passed through a column of microscopic beads that separate the fast moving, healthy sperm from the debris and dead sperm. Only the highly enriched fraction of good sperm is used for the insemination process. When severe male factor (very low sperm concentration, motility or normal morphology) is encountered, intracytoplasmic sperm injection (ICSI) may be performed. This procedure involves the microscopic injection of a single sperm directly into the egg itself. The Austin IVF embryologists are so experienced and proficient at ICSI that the fertilization rates that they achieve with this procedure are now essentially the same as those achieved with regular insemination for men with normal semen analyses. Following insemination or ICSI, the egg and sperm are placed in a specially regulated incubator. They are evaluated 18-20 hours later to determine if successful fertilization has occurred. A fertilized oocyte is called a zygote, which then develops into a pre-embryo. The pre-embryos are then transferred into a different culture media and grown in the laboratory for the next 2-5 days.

Embryo Transfer: This brief, painless procedure involves the passage of a small catheter through the cervix into the uterine cavity. Transabdominal ultrasound guidance may be employed on occasion to facilitate the easy placement of the embryos at the correct location within the uterus. No sedation is necessary for this procedure. Your physician, in conjunction with the embryologists will decide whether it is best to transfer your embryos on the third or fifth day following the oocyte retrieval. This decision is made based on the female partner's age, the fertilization rate and the number and grade of the embryos. Although we typically transfer embryos on Day 3 at the multi-cell stage, some patients who are young and/or who have many excellent quality embryos may be better served by delaying their transfer to Day 5. All patients undergoing PGS (preimplantation genetic screening) must have a Day 5 embryo transfer, as we do not receive the results of the embryo biopsies until the morning of Day 5.

Supplemental Procedures: Two days after the retrieval, you will begin taking progesterone injections in order to increase the likelihood of successful implantation. These injections will be taken until the pregnancy test and will then possibly be continued, based on your progesterone blood level. A blood pregnancy test will be performed 2 weeks following the retrieval, even if this falls on a weekend or a holiday. For those who do have a positive initial pregnancy test, serum hCG levels will be monitored and re-checked. An ultrasound will be performed approximately 3 weeks following the initial pregnancy test and may be repeated several times throughout the first trimester after which time, you will be referred back to your Ob/Gyn for appropriate obstetrical care.